Car­la Rauseo

It's be­com­ing a trend. Young peo­ple in their twen­ties, thir­ties and for­ties have been com­ing to To­tal Re­hab for phys­i­cal ther­a­py in droves. What kinds of in­juries should bring such young peo­ple to phys­i­cal ther­a­py? Think about it! If you said sport­ing in­juries like ACL re­pairs, an­kle sprains, mus­cle strains, then you are cor­rect! These are in­juries typ­i­cal of younger peo­ple.

So re­al­ly, this re­cent trend of young pa­tients in the clin­ic should not be sur­pris­ing. But it is. It is sur­pris­ing be­cause these pa­tients are not there to re­ceive ther­a­py for "ac­tive lifestyle is­sues," but for those con­di­tions that plague the old­er pop­u­la­tion. The rea­sons for this are re­flec­tive of the rat race that Trinidad has be­come to­day.

This re­al­iza­tion hit me square in the face this week...maybe be­cause I sud­den­ly have many young men in a sim­i­lar sit­u­a­tion all at once. It some­times hap­pens like that in the clin­ic. Two of these young men stand out as per­fect ex­am­ples of rat race vic­tims. Let me tell you their sto­ries.

Both men have back pain, but dif­fer­ent types. MRI's show the spines of two much old­er men, with de­gen­er­a­tion and arthrit­ic changes through­out. John (names are changed for con­fi­den­tial­i­ty), in his late twen­ties, has the resid­ual ef­fects of a bulging disc, and walks bent like an old man, with an ex­treme­ly stiff lum­bar spine. Tom, on the oth­er hand, is in his thir­ties and has ex­ces­sive mo­bil­i­ty in his lum­bar spine. He ex­pe­ri­ences pain in loaded po­si­tions like sit­ting, bend­ing and stand­ing. Both men are ex­treme­ly weak, with poor mus­cle tone, and an over­all "soft" ap­pear­ance through­out their bod­ies...not what one would ex­pect of young men in their twen­ties and thir­ties. Nei­ther is phys­i­cal­ly ac­tive.

Both men are self-em­ployed and are ex­treme­ly hard work­ers. Their phones ring con­stant­ly in the clin­ic, and busi­ness is con­duct­ed re­gard­less of lo­ca­tion or ac­tiv­i­ty. Dur­ing ed­u­ca­tion­al dis­cus­sions and demon­stra­tions, I can eas­i­ly tell that their thoughts are else­where, on what they have to get done, on what the busi­ness needs, on what meet­ing they must at­tend, and I of­ten won­der if any­thing we dis­cuss is re­tained.

Com­pli­ance with small home ex­er­cise pro­grams is lim­it­ed, at best. They of­ten can­cel their ther­a­py ses­sions, cit­ing an un­ex­pect­ed meet­ing, or the need to com­plete an un­fin­ished job, de­spite my best ef­forts at ed­u­cat­ing them on the im­por­tance of ad­dress­ing their back is­sues.

This week I point­ed out to them that their busy sched­ules were im­ped­ing the re­ha­bil­i­ta­tion of their back con­di­tions, as they were non-com­mit­tal and non-com­pli­ant. Tom's ex­cuse was that he had jobs to do that were more of a pri­or­i­ty. That ex­cuse was as­ton­ish­ing to me, giv­en that these jobs are the same ac­tiv­i­ties (lift­ing and bend­ing) that pro­duce his pain. I at­tempt­ed to ex­plain that to him, but his re­sponse con­tin­ued to be that these jobs were a pri­or­i­ty. I was stuck be­tween a rock and a hard place.

John's re­sponse was, "Well if we don't work hard, how are we go­ing to take care of you ladies?" A big dis­cus­sion then en­sued in the clin­ic. John was think­ing of the present and near fu­ture, rather than about his old­er years. I re­turned a ques­tion. "John, if you don't take care of your­self now, how are you go­ing to take care of your wife in the fu­ture when you can no longer work be­cause you have be­come crip­pled? Your wife will be the one do­ing the care-tak­ing!" To that he had no an­swer.

You see, these pa­tients are young men. The gen­er­al men­tal­i­ty is one of in­vin­ci­bil­i­ty and there is no thought of the con­se­quences of ac­tion and in­ac­tion on health and well­ness. Their main fo­cus is mak­ing mon­ey, the dol­lar signs, the job, the hus­sle. It is no longer un­com­mon to come across such in­di­vid­u­als. Ac­tu­al­ly, it is the norm. To find a young pa­tient who is proac­tive about his health is quite a rar­i­ty!

Women are not im­mune to this rat race dis­ease. They man­i­fest a bit dif­fer­ent­ly, with stress-re­lat­ed back, neck and shoul­der pain, poor pos­ture and gen­er­al­ized de­con­di­tion­ing be­ing the most com­mon pre­sen­ta­tions. They cite their de­mand­ing man­age­r­i­al jobs; the rush to or­gan­ise the chil­dren's trans­port to and from school, lessons, and ex­tra cur­ric­u­lar ac­tiv­i­ties, among oth­er wife­ly and moth­er­ly du­ties, as rea­sons for not hav­ing time.

For these pa­tients there is nev­er any "me" time, which is nec­es­sary to de-stress and care for them­selves, to ex­er­cise. As a re­sult, we are see­ing the emer­gence of very pre­ventable lifestyle-re­lat­ed mus­cu­loskele­tal con­di­tions in very young peo­ple. "Me" time is an in­vest­ment in one's life­long health, and one of the most pow­er­ful com­bat­ants against the rat race in which we live. Take my stu­pid ad­vice!

Car­la Rauseo, DPT, C.S.C.S. is a Doc­tor of Phys­i­cal Ther­a­py and Cer­ti­fied Strength and Con­di­tion­ing Spe­cial­ist at To­tal Re­ha­bil­i­ta­tion Cen­tre Lim­it­ed in El So­cor­ro.